The term selective mutism describes the behaviour of children who are able to speak but remain silent with certain people or in certain settings. It is a form of social anxiety.
Some children may choose to speak to specific friends, but not adults, others may only communicate in whispers when in certain settings like school, on the telephone, birthday parties.
Children with selective mutism are often misunderstood and may be wrongly punished for their inability to speak and communicate. Others are misdiagnosed with speech and language difficulties; autism, oppositional defiant disorder, or learning disabilities.
Children with selective mutism should not be forced to speak, as this leads to worsening of anxiety. Selectively mute children are not manipulative, nor are they developmentally delayed; they are simply too anxious to speak. It is most commonly noticed when a child joins a school.
Causes of selective mutism
There’s a variety of causes of selective mutism but as it is a phobia, most are associated with anxiety. Children literally become too distressed to speak.
Some children have trouble processing sensory information like loud noises and can shut down when overwhelmed. If a child has a speech and language disorder or hearing problem, it may also contribute to making speaking stressful.
There is no evidence that children with selective mutism are more likely to have been abused, neglected or suffered trauma than other children.
Diagnosis of selective mutism
The diagnostic criteria for selective mutism are:
- Consistent failure to speak in specific social situations (in which there is an expectation for speaking, such as at school), despite speaking fluently in other situations.
- The mutism interferes with educational or occupational achievement or with social communication.
- The duration of the disturbance is at least one month (not limited to the first month of school).
- The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
- The disturbance is not accounted for by a communication disorder (stammering, for instance) and does not occur exclusively during the course of a pervasive developmental disorder (like autism).
Prevalence and diagnosis
1 in 140 children are selectively mute and it occurs more in girls than boys, particularly girls who are learning a second language. Selective mutism starts in childhood, usually between the ages of 2 and 4 but may persist to adulthood. When it persists for a long time teachers and parents may experience high levels of frustration and even anger.
Children tend not to simply grow out of selective mutism, so when the condition persists a planned approach is usually helpful.
Approaches and interventions, which require patience, time and imagination, tend to work best when they occur in the places where the child does not speak. However, the involvement of the parents is critical. It is not helpful to insist a child speaks.
How schools can help
It is essential that all adults who come into contact with the child are aware of the difficulty. They must not react excessively when a child speaks in a social situation, even by praising it, as this will add to the child’s self-consciousness.
Teachers and support assistants can:
- Place an emphasis on activities that do not involve spoken language, such as gesture, writing, silent reading, and drawing.
- Allow the child to communicate by other means such as via the computer.
- Place the child in small groups for classroom tasks. A child with selective mutism normally benefits from being in a mainstream class, and from working and playing with other children.
- Practise a gradual merging-in approach, when the child is playing happily with a friend.
The speech and language therapist, educational psychologist or Child and Adolescent Mental Health Services (CAMHS) may be involved in planning an intervention programme for the child. Parents and others, with whom the child does speak, should be involved, but the targeted activities should be carried out at school. As more speech emerges, other people may be involved gradually.
This disability is usually overcome, but the best chance the child has is when the school works closely with parents and outside support services.